Provider Demographics
NPI:1588729545
Name:DON JABLONSKI DO PA
Entity type:Organization
Organization Name:DON JABLONSKI DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANN
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:828-890-3200
Mailing Address - Street 1:PO BOX 2108
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729
Mailing Address - Country:US
Mailing Address - Phone:828-890-3200
Mailing Address - Fax:828-890-3223
Practice Address - Street 1:2 ETOWAH SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:NC
Practice Address - Zip Code:28729
Practice Address - Country:US
Practice Address - Phone:828-890-3200
Practice Address - Fax:828-890-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501669261Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347899Medicare PIN
NCD27363Medicare UPIN